Not sure, just sent Kefu a note. Still have occasional flare-ups and can’t seem to get to the root cause but hitting my psoas with a theracane whenever I feel myself tightening up works. I’m back to riding bikes about as fast as I was pre injury and ski touring without any issues.

As crazy as it seems most of the tightness has gone away since I’ve gone on a strict gluten free diet and my body started taking in all the nutrients and electrolytes I was missing. Still get some weird fasciculations, but hoping these go away with time. I’ve been going pretty hard ski touring and cycling and while I get a little tightness afterwards it doesn’t really bother me or cause me pain. Kefu, any updates on how you’re doing?

I’ve had some luck managing my symptoms, but haven’t gotten to the root cause. Main things I do to manage the tightness are mckenzie pressups, foam rolling lumbar and thoracic spine, releasing the psoas on my affected side, and dry needling the lateral quad. I’ve put a lot of work into my core, glutes, and hamstrings with limited results. Seems like some movements cause tightness while others help, I need to focus on what helps going forward. Wondering if I need to do more single leg exercises as I think this is mostly stemming from a muscle imbalance that I continue to perpetuate.

Right now it feels like the psoas on my affected/tight side is getting overworked. I mostly notice it after completing an activity but sometimes during. It presents as a tight it band/lateral retinaculum and causes some lateral knee pain. I’m into endurance sports that involve lots of knee flexion, cycling and ski touring. I also feel like the glute on the affected side isn’t firing like it should because of the dysfunction so I’ve been trying to concentrate on it as well. Haven’t seen my PT in quite sometime as I wasn’t seeing results and it’s expensive, but might go back to have him check my leg length as I previously had a functionally shorter leg on my affected side.

Just started incorporating some more upper body work like horizontal rows and scap push ups to see if it’s something further up the chain that might be contributing to a movement pattern affecting my gait. The activities I participate in push you for a couple hours on end, I feel as though as I start getting tired my form suffers causing other muscles to take over that shouldn’t.

djrachman, I’ve also found that hamstring work and posterior chain work in general helps my symptoms, but for me it seemed like it was a temporary fix.  So far doing the Mckenzie exercises seem to help the most, but aren’t a cure all.  I’ve been riding my mtn/road bike about 80 miles a week for the last couple weeks and my symptoms were under control, but a couple days back I did a 25 mile mountain bike ride with lots of vert and I started to get some lateral knee pain again.  I think I just overdid it and stayed in a position where my spine was in flexion for too long.  

Jake, you didn’t mention whether you’ve seen a good PT.  Not all are created equal, so make sure you research and try to find one that will try to come up with a diagnosis and treat the cause of your imbalances vs just treating the local issues.  Sounds like you have a lot of layers to peel back and try to fix. 

Went to go see the new PT again today, she thinks it’s an issue with discs near l1/l2.  The press-ups are definitely helping, if I feel tightness in my lateral knee I go do a pressup or standing back extension and am good to go for a bit.  My IT Band is the loosest it’s been in a long while when I palpate it.  She gave me some additional things to work on, including some movements to target right between the thoracic and lumbar spine.  Next step is to continue the pressups and other movements she gave me.  Trying to continue to stay out of flexion and the movements that are keeping my symptomatic.  She said if I can stay symptom free for a week we can start working on additional strengthening for my upper and lower back.  I never target the upper back.  But exercises that have targeted the lower back have seemed to help in the past.   She also had me practice keeping my transversus abdominis tight while doing bird dogs, which I don’t think I’ve done before. She taped my back again to remind me about posture.

Thanks dj.  I usually don’t get pain upon squatting, but the tightness and pain return after.  I feel like maybe I’m compensating with some overactive muscles and then they tense up after.  I’ve been doing posterior and core strengthening the last couple days, seems to help, but always have that slight tightness that I know will come back once I stop.  I’ve wondered this before, but I’m really curious about a possible disc issue.  I don’t present with any back pain, although I’ve had a couple twinges here and there, never anything debilitating or something I thought I should have a doc check out.   I know most people have disc issues when they receive an MRI, but most have no symptoms.  I’m not sure an MRI would help anyways, am I going to have back surgery at this point, very unlikely. 

Another thread I’ve had going for a bit, with some different perspectives, think there might be some useful info in it.

http://www.tetongravity.com/forums/showthread.php/264615-ITB-Issues-What-Worked-for-You